Coronial

108 results for blood test

QLDhospital2016-02-17

Dickinson, Rick Dudley

55y · Male·Cardiac tamponade due to ruptured aortic dissection (Type A) against a backgroun…

Rick Dickinson, a 55-year-old man, presented to St Andrew's War Memorial Hospital after experiencing severe central chest pain and lower back pain with numbness at the gym. The treating senior doctor failed to adequately…

emergency medicinepathologydiagnosticcommunicationmorphine
SAhospital2014-02-05

Coroner's Finding: COOK Eileen Hazel

76y · Female·hospital acquired pneumonia, multiple organ dysfunction and small bowel obstruct…

Mrs Cook, a 76-year-old woman, died in January 2010 from hospital-acquired pneumonia, multiple organ dysfunction, and small bowel obstruction. She was admitted to a rural hospital with acute renal failure and dangerously…

general practiceemergency medicinediagnosticcommunicationintravenous fluids
SAhome2013-09-03

Coroner's Finding: KROMWYK Shane Andrew

38y · Male·mixed drug toxicity and arrhythmogenic right ventricular dysplasia

…ive methadone—all two weekend 'takeaway' doses plus his supervised daily dose—achieving potentially lethal blood concentrations. Critical clinical lessons: (1) Kromwyk manipulated multiple doctors ('doctor shopping') wi…

general practiceaddiction medicinediagnosticmedicationmethadone
QLD2025-10-08

Inquest into the death of Peter Owen Pilkington

48y · Male·gunshot wound to chest

Peter Owen Pilkington, 48, died from a gunshot wound sustained during a police siege on 6 December 2021. After escalating behaviour at his NDIS support office in Stretton, Queensland, Peter produced what police believed …

emergency medicinetrauma surgerysystemmethamphetamine
WAmental health2018-07-16

Inquest into the Death of Stanley KING

45y · Male·Cardiorespiratory arrest due to coronary artery disease, severe psychosis requir…

Stanley King, a 45-year-old man with severe psychosis, coronary artery disease, and obesity, died from cardiorespiratory arrest triggered by antipsychotic-induced laryngeal dystonia. Admitted involuntarily for acute psyc…

psychiatryemergency medicinediagnosticmedicationzuclopenthixol
WAmental health

Inquest into the Death of Vincent Tavita Tolai SCHWENKE

24y · Male·complications of ligature compression of the neck (hanging)

Vincent Schwenke, a 24-year-old male of Maori descent, developed acute psychotic symptoms after ceasing cannabis use and was admitted to a secure mental health unit as an involuntary patient. Despite initial improvement …

psychiatryneurologyescitalopram
QLDhospital2015-07-27

KS - Non-inquest findings

69y · Male·Intracerebral haemorrhage due to sepsis (Staphylococcus aureus bacteraemia), com…

A 69-year-old man with a history of myocardial infarction and atrial fibrillation presented to a rural hospital with fever, lethargy, tachycardia and elevated troponin. The treating doctor diagnosed NSTEMI based on the e…

emergency medicinecardiologydiagnosticmedicationrivaroxaban
WAhospital- 8 July 2014

Inquest into the Death of Delray BEASLEY

56y · Male·unascertainable; complications of liver cirrhosis and/or exposure most likely

Delray Beasley, a 56-year-old Aboriginal man with chronic liver cirrhosis from longstanding alcohol abuse, was admitted to Kalgoorlie Hospital in May 2010 following an alleged assault. He was initially evaluated for poss…

emergency medicineneurosurgerysystemdiazepam
WAhospital2022-01-25

Inquest into the Death of Carole LIVESEY

54y · Female·unascertained

Carole Livesey, a 54-year-old woman with severe anorexia nervosa and major depression, absconded from Rockingham Hospital psychiatric unit on 3 October 2017 during an escorted walk in hospital grounds. She had been an in…

psychiatrygeneral medicinecommunicationproceduralfluoxetine
VIChospital2021-07-22

Finding into death of Christian Joy

34y · Male·Cardiac tamponade due to hemopericardium from acute aortic dissection of the asc…

A 34-year-old previously healthy man presented to the ED with sudden-onset central chest pain. He was discharged with a diagnosis of GORD after negative troponin and symptomatic relief with antacids. A chest X-ray showed…

emergency medicineradiologydiagnosticcommunicationmorphine
SAhospital2008-06-06

Coroner's Finding: AUSTIN Grant Aaron

29y · Male·aspiration pneumonia complicating acute and chronic Wernicke's encephalopathy an…

Grant Austin, a 29-year-old man with intellectual disability and morbid obesity, died from aspiration pneumonia complicating Wernicke's encephalopathy. He presented with prolonged refusal to eat and drink from December 2…

general medicinepsychiatrycommunicationdiagnostictrimethoprim
NSWhospital2018-06-06

Inquest into the death of Dr Malay Rana

27y · Male·Loss of airway control and blockage due to aspiration from complications of a sm…

Dr R., a 27-year-old physician with cystic fibrosis, died from aspiration and airway blockage secondary to a small bowel obstruction whilst under dual respiratory-surgical care at Westmead Hospital. Critical clinical les…

respiratory medicinegeneral surgerycommunicationdiagnosticfentanyl
QLD2011-11-03

Currie, Sheldon Douglas

18y · Male·Hypoglycaemic hypoxic-ischaemic encephalopathy, due to massive liver necrosis, d…

…elayed, though unlikely to have altered outcome. Systemic failures included failure to order liver function tests when hepatitis diagnosed, lack of structured assessment protocols for antiviral treatment eligibility, and…

general practicegastroenterologydiagnosticcommunicationflucloxacillin
NSWhospital2026-01-13

Inquest into the death of Paul Harris

43y · Male·Bilateral pulmonary thrombo-emboli; contributory factors included obesity, coron…

… records. Paul was never transferred to Griffith Base Hospital for CT pulmonary angiography (CTPA)—the only test that could have definitively diagnosed PE. The coroner found that PE should have been considered earlier, t…

general practiceemergency medicinediagnosticcommunicationceftriaxone
WAhospital2020-09-04

Inquest into the Death of Malakai Matiu Ward PARAONE

0y · Male·Complications in association with fulminant sepsis in an infant (Streptococcus p…

… blanching rash, discharge occurred with parental consent. A GP visit on 24 August resulted in appropriate blood test orders but the family delayed testing. At Rockingham General Hospital on 25 August, septic shock was …

emergency medicineintensive carediagnosticcommunicationparacetamol
WAmental health2021-10-22

Inquest into the Death of Russell David BROCKLISS

38y · Male·acute cardiac arrhythmia in a man with cardiomegaly, focal coronary atherosclero…

…ted low oxygen saturations and high-risk cardiac status; a missed opportunity to perform pulmonary function testing during his April-May 2019 admission; failure to obtain physical observations on the evening of 7 June wh…

psychiatryemergency medicinedelaysystemrisperidone depot
QLDhospital2017-09-20

Mrs R-W - Non-inquest findings

83y · Female·Hyponatraemic encephalopathy due to adverse effects of citaprolam and duloxetine…

…gmented consultant involvement. Earlier identification of the chronic hyponatraemia, more frequent sodium retesting, and stricter documentation of escalation procedures could potentially have altered outcomes.

general medicineemergency medicinediagnosticmedicationcitalopram
WAhome2012-06-29

Inquest into the Death of Operation Lantana

Toxicity from intravenous caesium, DMSO, and other substances administered as pa…

…mely dangerous, and caused or significantly accelerated their deaths through metabolic derangement, gastrointestinal hemorrhage, cardiac arrhythmia, and sepsis. Patients and families were misled about risks and success r…

general practiceoncologydiagnosticproceduralcaesium chloride
QLDaged care2009-05-05

Hoy, Raleigh

41y · Male·Dilated cardiomyopathy

Raleigh Hoy, a 41-year-old man with schizophrenia and autistic spectrum disorder, died of dilated cardiomyopathy at a residential care facility (Tarampa After Care Centre) in Queensland in January 2007. While his mother …

psychiatrygeneral practicecommunicationsystemclozapine
VIChome2026-04-17

Finding into death of Simon Christopher Gaskill

50y · Male·unascertained

Simon Gaskill, aged 50, was found deceased in sand dunes at Ocean Grove Beach in April 2022 after sleeping rough for months. He had been discharged from hospital in December 2021 following treatment for severe alcohol wi…

emergency medicinegeneral medicinecommunicationsystemalcohol

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